申请医学院：该怎么准备综合推荐信Composite Letter？

If you are considering medical school in the future, it is important to begin thinking about the components of the application very early in your undergraduate career.  Unlike the application for undergraduate studies, the letters of recommendation process is more complex and who you choose will define you in the application you submit.

In addition to great grades, research work, publications, presentations, clinical experience, volunteering and excellent MCAT scores, you must also include a Composite Letter (CL).  The CL is the main recommendation letter that medical schools will review, and it consists of 3-5 individual letters from your selected reference providers.  Thus, to apply to medical school you will need to request recommendation letters from 3-5 individuals, and then your CL writer will integrate all of these letters into one summarized Composite Letter.

I write this article to advise you on how to approach the CL.  I am proud to say that when working in top tier institutions, 100% of the students who asked me to write their CLs were accepted into medical school.  

If you are considering medical school, meet with your school’s pre-med office as early as freshman year. Schools have two ways in which to determine the CL writer:  one, you select who you think would be best, and you ask them yourself or two, the school has a designated person to write composite letters and you do not have a choice in this. There are pros and cons to each situation.

If you are able to select your own CL writer, you can choose someone who knows you well and is invested in your success; having a person who is an academic and has knowledge of how to write is, of course, also important.   An advisor, a dean, or a long time professor are ideal candidates for this role. When writing CLs for my students, I was able to enhance and supplement the knowledge that their recommendation letters offered; for example, when writing a CL for one of my students (who was an athlete), I could add in words from his coach’s recommendation letter but also talk about how his peers spoke of his commitment to his studies, since I also knew his teammates. The cons of having to select your own CL writer is that they may be new to the process, may not spend their time doing this regularly, and consequently, there will be variations in the quality of CLs. 

If you are not able to select your CL, your institution has likely designated pre-health advisors (or various staff) to write these letters for all the medical school applicants at your school.  They may not know you at all aside from a meeting or two to discuss your medical school ambitions, but on the plus side, this is part of their day to day job.  Thus, they are more ‘experts’ in writing these letters because of their jobs, though they will not be able to speak about you as personally since you have no long standing relationship with them.  Schools that designate CL writers ensure that all their medical school applicants have a similar quality to their CL letters.

Whether or not you can select your CL writer is not something that you can change because this is often school policy. However, what you can control is who you will ask to submit letters on your behalf.  Typically, you can ask 3-5 individuals to submit letters that would become part of your final CL.

Selecting who will write your letters of recommendation is always a process — be it for undergraduate, graduate or medical school applications.  

Importantly, do not ask your CL writer to also be one of the 3-5 reference writers.  Because they read all of the recommendation letters in order to summarize them to create the CL, they will have space to add their thoughts into the CL when they write the CL. Thus, do not waste one of your reference letters because a savvy CL writer will know when to inject their voice into the CL. 

For medical school  it is best to select individuals who know you in different ways. Do not select five professors who have taught you in five different science lecture classes.  What they would know about you would be similar, and thus, there is no space for your uniqueness to shine — they taught you in a science class, the course was set up as a lecture, their delivery of information in the class is similar to all the others (which means how they interact with you is the same).

You want to think about variety in these 3-5 letters:  who has seen me excel in a lab, who has seen me engage with peers to manage a team, who has seen me actively working within my community? While you might think it would be great to have 3 letters of recommendation from professors who gave you an “A” in their science class, it might not work in your favor.  If they never saw you actively work, never talked to you to see how you solve problems, or cannot speak directly to your work ethic beyond “she earned an A easily in my class”, that does not say anything more than what the medical school will see on your transcript.  However, if you earned a “B” in another class but started off with low grades but met with your professor regularly, engaged with the professor in office hours and research, plus showed an ability to overcome your weaknesses, you have a letter that demonstrates your resiliency.

People who have seen you in volunteering roles, clinical roles or positions outside of the classroom are also important; with up to five recommendation letters, you should think beyond the classroom for your letter writers.  For example, coaches often add a facet to students that professors cannot: coaches see students lose at games and come back to play, they see them overcome injuries, and they see them argue with teammates but still band together to meet a greater good.

Whatever you do, things to keep in mind:  You want to ask these individuals early to one, see if they are willing to write on your behalf (remember, they can say no) and two, give them plenty of time to request materials from you (e.g., resume, publications, transcripts)  and write the letter.  These individuals do not get paid to do this work, and it is a kindness that they are offering to you. Be considerate of their time and acknowledge them with gratitude; if for some reason you need to ask them for reference letters again, you want them to remember you positively and be inclined to assist you (because, again, they are not obligated to do so).  Most writers like to hear the results of your application, so it is always courteous to update them if you are accepted and make a decision on where you will matriculate.

I know that the medical school application process is a tough one, and I hope the insight provided about the Composite Letter will help you make wise decisions about who to ask when it comes time to seek out reference letters.  Certainly there are many other factors to consider in your application, but I hope that starting you off here is helpful.